Time in Madagascar

A Peace Corps volunteer's attempt to share his experience engaged in grassroots community health education in Madagascar, Africa.

Wednesday, June 28, 2006

writing now from the states once more, having decided to bring my peace corps service to an 'earlier than planned' close after 8mos in Madagascar. will elaborate on my reasons for doing so below. in no way an indication that i regret the experience. i feel incredibly lucky to have had the opportunity to do this type of work and to have gotten the peek into what life is like elsewhere. it was a rich, unique experience that i gave much to and got much from. it many ways it met my hopes and expectations...specifically with regards to wanting to strip life back down to the essentials of clean water, good food, shelter from the elements, and meaningful relationship with others...and wouldn't trade it for anything. and in the end, it was harder to leave than i thought it would be, mostly due to the relationships i entered into with people in ambalavao. amazing how attached you can get to a place and people in such a short time.

i have been back now for a little more than 1 week. the transition/readjustment has been challenging. such a drastic contrast to what i grew accustomed to in madagascar. one extreme to the next...from scarcity to abundance (i.e. watching dirty, shoeless malagasy children sitting on the dirt road playing 'kitantara' with rocks...and loving it...to arriving here and being surrounded by many with their laptops, ipods, portable dvd players, digital cameras, and cellphones), quiet solo time to large-group social gatherings (centered around some significant family events in the way of a wedding and celebrating my parents' 50th anniversary). and any social skills i may have once had seem to have taken a hit from spending 8mos in a non-english speaking country. it's been a shock on the senses to say the least. and perhaps i should collect on the voucher i was given before leaving entitling me to three counseling sessions with a certified therapist for 'readjustment' purposes.

the most often asked question since returning is along the lines of, "glad to be back?". my reply has been something to the effect of...i'm alot of things and, yes, there's a bit of glad in there. but, there is quite a bit of remorse as well. remorse that i may never go back to this place that i gave some of myself to; that i may never see these people who i grew close to and care about; that i will lose the use of this newfound language. that's sad. there is already much about my existence in ambalavao that i miss and long for. the open-air market atmosphere, the necessity of walking or cycling from place to place vs. being dependent on an automobile, the forced self-reliance due to not having the option to simply run out to buy what you need (peanut butter jumps to mind), the small scale of commerce (esp. the roadside vendors) and knowing with pretty good certainty where your money is going. i think the supposition is that surely it must be a relief to be back and to have all the amenities and luxuries that we are privileged to have here in the US. but it certainly isn't all get and no give. yes...one gains much from returning to this setting but also loses a bit. i try to explain that yes, madagascar has more than it's fair share of problems, issues and challenges, esp. in the context of public health that are unique to being a poor, developing country in the tropics. but we too have ours that are very unique to this culture, lifestyle, and setting. much having to do with the fast-pace that is incredibly hard to keep up with (pretty certain there is no word or phrase for 'multi-tasking' in the malagasy language) and the stress that follows...in a rush much of the time with an endless to-do list; not knowing if we're coming or going...which results in a collective psyche that is highly scattered, distracted, and anxious much of the time. the overabundance of stimuli coming in contributing to short attention spans and poor listening and communication skills. not to mention the prevalence of such health issues as diabetes, colon cancer, and joint deterioration/arthritis often the result of poor diet and exercise. and yet, most malagasy believe, from any exposure they've had to life in the US (mostly in the form of film and music videos), that all one needs to do is arrive to the United States and life is handed to you. the land of plenty (which it is), of milk and honey. i always did my best to dispel this myth and try to explain that life's hard, no matter where one lives. you simply trade one variety of challenges and problems for another.

so my reasons for opting out...a totality of reasons for sure but primarily related to work and family. i have my RN license but always made the point to declare when it came up that i am still much more a nursing school graduate than a nurse...having just graduated from nursing school before arriving to madagascar. and simply felt that my schooling and license were being under-applied in this role and setting. i went through alot to get this license and it's time to start using it in a bonafide nursing position. i was drawn and sought out this opportunity because i was not (and still am not) much tempted by taking a conventional nursing position in a busy, fast-paced, understaffed hospital with a lop-sided patient-to-nurse ratio...a lose-lose arrangement for both nurse and patient. and one that would be a disservice to myself and any patients that fell under my care. and i am still hoping to avoid such a setting. and thought this a worthy avenue to get into public health. which is still quite a viable possibility down the road after paying my dues, and spending a substantial amount of time in a clinical, curative setting.

i have my work cut out for me in putting the pieces in place for what lies ahead. there are any number of possible scenarios and the crystal ball is a little hazy (as our 60yr old crew boss from my seasons on a backcountry trails crew in the tetons was apt to say...miss you GW)...but before too long i should be working as an RN in Colorado. Fell in love with the mountains years ago and looking forward to continuing the affair. i am trying to approach this process of getting 'settled' and established as a welcome challenge vs. drudgery. for 'it' becomes what we tell ourselves it is.

i thank you all for taking an interest in my endeavors, lending support, and wishing me well. i still have hopes and ideas to post some pics now that i have steady access to the web. may you be free from all internal and external harm. happy, joyful and light. healthy and well. and may you live at ease from well-being.

Saturday, June 10, 2006

So i'm not sure if any of my previous posts have given a good, succinct overview of the nature of my work here. which deserves to be done. my role could best be described as 'grassroots community health educator'. We (that is, peace corps health volunteers) are commissioned by the Madagascar Ministry of Health to address certain health issues unique to life here in Madagascar...specifically, good nutrition (esp. targeted at pregnant woman and young children); healthy pregnancy; vaccines for the newborn through 1yr old; prevention and treatment of diarrhea mostly through sound hygiene practices and treating drinking water with chlorine (as there is no large scale water treatment process); prevention and treatment of acute respiratory disease (high prevalence due to using wood to cook and the abundance of smoke in the often poorly ventilated kitchen that hinders and eventually renders ineffective the natural defense mechanism of cilia lining the trachea); prevention and treatment of malaria; family planning; and finally reproductive health esp. targeted at adolescents and prevention of STI's/HIV/AIDS.

i work every weds. morning at the clinic weighing the women who come for family planning 'consults' (i.e. to collect a 3mos supply of the pill or get their depo-provera injection...also good for 3mos) and then typically commence a teaching on HIV/AIDS. The other days I typically go out on foot or bicycle to the outlying rural villages to address some of the above mentioned topics. i speak almost entirely with women and children. There is a saying in this line of work of public health in the context of the 'developing world' that i believe rings pretty true: teach a man and you've taught one person; teach a woman and you've taught a whole family.

Tuesday, May 16, 2006

I’ve come to believe that the greatest misunderstanding with regards to HIV/AIDS in need of remedying here in Madagascar (and i suspect many places elsewhere that share some of the same challenges as this place) fall into two categories: the belief that you have to do something wrong in order to become infected (ie that infected people deserve the illness due to immoral or mis – behavior) and the idea that if you dont have HIV/AIDS, its not a problem for you (ie your life goes on ‘business as usual’ and you remain unaffected). There are questions I ask of the malagasy as a regular part of my teachings and the answers I get are oftentimes concerning. Such as...1) T/F? Tokony ho’menatra ny olona izay voan’ny VIH/SIDA (people who are infected should be ‘shy’, or in other words, should be kept away from the community at large). Most reply true. 2) Mino ve ianao fa tsy maintsy maditra mba ho’voan’ny VIH/SIDA (do you believe that you have to misbehave/do something bad or wrong in order to get HIV/AIDS)? And 3) Raha tsy voan’ny VIH/SIDA ianao, dia mila miahy momba ny aretina ve ianao? Izay hoe, mampiova ny fiainanao ve ny aretina SIDA (raha tsy voan’ny)? (If you don’t have HIV/AIDS, do you need to care about the disease? That is, does AIDS change/affect your life if you are not infected?). Might be worth mentioning that when i posed Q 2 to my friend who oversees the operation of the upstairs of the clinic devoted to reproductive health of adolescents (where i plan/hope to post teachings on these very issues before leaving) and Q 3 to my counterpart, a malagasy doctor...they both gave the answer of misunderstanding. Now there is still a pretty large language barrier to contend with and i remain very humble about my so-called language ‘skills’...but if the communication of ideas was as effective as i believe it was, it is very concerning indeed that people who are supposed to be knowledgable about such things and in positions to influence and guide the views of others less knowledgeable hold such views.

Also worth mentioning, having to do with the above, the religion gets into the mix with views on AIDS here. In that, many believe if one prays diligently enough, they will remain uninfected. And the idea that AIDS was sent by God as punishment to those who are bad people and are guilty of committing some sort of sin. Of course, when you buy into such thinking, it makes leaving or turning your back on that person much easier. So I have been devoting alot of my teachings and energy to dispelling these beliefs and trying to illustrate that one need not do anything wrong to become infected.

Saturday, April 15, 2006

writing on easter sunday from morondava on the west coast with the mozambique channel that separates madagascar from mainland africa washing the shore. my ideas for spending a few accrued vacation days morphed into 3 days on bike/paved road 220km; 3 days on river hiring a malagasy guide and renting a canoe/>100km; and 2+days on bike again/sand road 165km. a bit overly ambitious and unrealistic, my original plan. but entered into these days with no fixed agenda...an approach to travel that i am a big advocate of and one that seems to agree with me. most of the others in my 'stage' (ie those others with whom i arrived and trained...we number 15 now down from 18) were going together to a resort area on the east coast. it was a no-brainer for me to opt for a small-group vaca centered around physical activity vs. a large group, sedentary outting. for me, there is definately an inverse relationship between the size of the group and the quality of the interaction. granted...'1' is a pretty small group and doesn't provide for too much interaction. though i was only one when mobile and had some incredibly unique exchanges with malagasy people along the way. am having a bit of a love affair with the bike that we were given for work purposes and love that mode of transport as it affords the opportunity to see the landscape as it slowly passes by and allows one to still be engaged with the communities and roadside shops along the way.

not sure what all is worth sharing from my trip. it was all very 'off the beaten path' and people were always surprised to find out that i was on my own. the time on the river wasn't all that stimulating and the heat was downright brutal. but i was ready for a break from climbing hills on the bike (as well as giving my hindend a break from the 4-5 hours on a bike seat each day). i was reminded that my most satisfying outtings with others have involved sharing the work equally and a mindset very near to not wanting to be anywhere else, doing anything else, with anyone other than those whom one is with. and these criteria were not in place for this particular river trip. meaning...the malagasy guide whom i hired (and as a general rule i strongly dislike having to hire a guide for any type of outdoor pursuit, feeling savvy and experienced enough at this point to be able to take responsibility for my own good time and well-being) pretty much catered to me each meal and my guess is that he would have much rather been anywhere else, doing anything else, with anyone else (ie esp. his wife and children, which is easy enough to understand). shortly before rolling into town here my route took me through the 'avenue of the baobobs'...definately 'on-the-map', so to speak. very freakish/unique/impressive trees found in few other places.

other than that, i guess i've decided that what is in stark contrast here vs. the life that i'm used to back home is the lack of diversity...diversity in the diet and foods that are available (i was expecting abundant tropical fruits all along my route which was far from the case. and little to no vegetables); diversity in the economy (i told my river guide that, just as an example, if there were 20 different lines of work here in madagascar, there are at least 100 in the US); and diversity amongst the people. though there are 18 different 'tribes' here with distinctions amongst one another, they are still all malagasy. i guess what comes to mind here is the deeply ingrained custom to call attention to a white person (or any non-malagasy for that matter) by shouting enthusiastically (esp. the children) "salut vazaha!" (a combination of french and malagasy that translates to 'salutations stranger'), which i have been told and believe is in no way meant in a derogatory manner but which, for me, is hard to be ok with and feels a bit dehumanizing...which i think applies anytime you are giving someone a label based on some physical attribute or difference that they have from you. my way of handling it is completely contingent on my mood, the person doing the salut-ing, and my perception of what their intention is. at times, i give no reply so as to not reward unwanted behaviour. there are other times when i reply with the equivalent of 'hey there malagasy', hoping that it might occur to them that it isn't altogether pleasant to be referred to by what you are vs. who you are. and then there are times when i explain that said once and not yelled, all well and good. but shouted repeatedly is not appreciated. and try to explain that if they were to visit the US (which is a longshot multiplied over and over for most), they would not be treated the same with US nationals yelling 'salutations malagasy!' or worse, "salutations dark person!". but realize that this is because we are so used to seeing people of all sorts and backgrounds and they simply are not. and indeed, the diversity that we enjoy as a country must surely be our greatest asset. for as science has shown, the more alike a population or species becomes, the fewer damaging events it takes to achieve their demise. so...Godbless diversity!

Saturday, April 01, 2006

so today marks 6 months in country and i am in the capital of antananarivo awaiting the 3-day training session that all volunteers take part in after being at site for 3 months (though it has been closer to 4 months for us). i had a steady february, yet a slow march. have taught HIV/AIDS lessons at the local highschool and middle school. but my primary work continues to be making trips out to the rural villages doing presentations and i have been devoting most of my time/energy into HIV/AIDS awareness and education. The social climate is ripe here it seems for the disease to take hold. Promiscuity and infidelity are quite commonplace. I highlight three main messages...you can't tell my looking if someone has HIV/AIDS; we shouldn't abandon people who have AIDS (given that there are so many ways that it is not spread); and prevention is very easy (given that there are very few ways that it is spread). I use a comparison that S. Africa 10 years ago was where Madagascar is today (about 1 in 90 prevalence rate). And show them where S. Africa is today (about 1 in 3) and tell them i am trying to scare them. But just a little. And use the analogy of climbing in that when i am climbing, as long as i'm a little scared (vs. being too scared), that my mind is more focused and i am better able to protect myself from harm. But stress that i in no way want them to be too scared, which only leads to abandonment and stigmatiztion. And spend alot of time showing all the ways that the disease is not spread. And devote a good bit of the teaching to showing a picture of three couples and telling a story involving infidelity and how even the partners who are faithful and only have sex with their spouse/sign. other are still susceptible and get the disease from their unfaithful other. A common, strong reaction to learning that one is infected is to assume they are a bad person and did something wrong that they are being punished for. And many believe these bad people should be locked away and not allowed to interact with the outside community. I hope it hits the mark.

Otherwise, my 3 main complaints/challenges remain unchanged...the unwanted attention (god i miss my anonymity and now know what it must feel like to be a rock star); not being able to (more) fully express wants, needs, thoughts, and ideas (given the lingering, unavoidable language barrier); and the isolation and being cutoff from the outside world.

otherwise i am very excited about cashing in some accrued vacation days and have plans to embark on an extended cycling trip covering 990 km and just under 2 weeks going from the interior to the west coast. such a great mode of transport and allows for bonafide interaction with communities that one passes through. and having a bit of a handle on the language, allows for some unique exchanges not afforded the 'typical' tourist.

will wrap up with a bit of a story...discovered first hand this past week a custom that i had been told existed. it has to do with parents employing deceipt and fear to get children to behave. still not entirely sure how widespread the practice is. as i was walking along an alley on my way home one early afternoon, a malagasy woman and her young daughter about 2yrs old (though she could easily be 2x that age due to the nutritional deficiency that exists here. i have met 14 and 15 year old boys that you would swear were no older than 8 or 9 by our standards) were drawing water from the community spigot. anyway, as i got near to them, the mother bent down and was whispering into the little girls ear and pointing me out. i very deliberately approached and asked what she was explaining to her daughter and she forthrightly admitted that she was telling her if she was naughty, i would eat her (this is also related to the decreased diet as we foreigners are seen as unnaturally big in their eyes). now i had just come from the market with a sack of produce and showed the little girl the contents and told her that, like everyone else, i liked eatting pineapple and mangoes and peppers and not malagasy children who are naughty. and proceeded on my way home declaring loudly while walking down the street (in malagasy of course) that i do not eat malagasy children who are naughty. so now i finally know why when i arrive at a rural village, many of the children run off in terror.

Friday, December 02, 2005

wow. as much as i predicted that regular posts on this blog would be few and far between, i could not have predicted that they would be this few and far-between. little time and much to say. our 2mos. of training is now all but over. we (the 16 of us that make up the health 2005 'stage') disperse to our respective sites this next week. i will be going to ambalavao and feel very lucky about that. had a 4-day site-visit that was very positive at a time when i needed it, as i had been flirting with ideas of bailing on this plan.

so to attempt to recap...it was 'hit the ground running', instant and complete cultural immersion. pretty much has lived up to the romanticism that most conjure up when imaging what peace corps is like, page out of national geographic-esque. the initial shock of life in a developing third-world country has subsided and what was once shocking has now already taken on a sense of normalcy. amazing what you can get 'used-to'.

Archives

DISCLAIMER: This is a personal website created and maintained for the sole purpose to inform friends and family of my experience as a Peace Corps volunteer in Madagascar. Any expressed views or content are personal in nature and in no way reflect the views of the U.S. government, the U.S. Peace Corps, or Peace Corps Madagascar.